| NPI | 1902885452 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R9F27) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 2743) |
| 207Q00000X Family Medicine (Licence: MN 48303) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2016-02-11 |